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Concerns about health and “deaths of despair” may have helped tilt the 2016 United States presidential election in favour of Donald Trump, according to an analysis of nationwide voting patterns and mortality rates.

Researchers led by Lee Goldman from New York’s Columbia University Irving Medical Centre used publicly available data from 3112 US counties to compare each county’s change in age-adjusted death rate between 2000 and 2015 with its net percentage Republican gain or loss in the presidential elections of 2016 and 2008.

Their findings call into question the idea that economic disadvantage – characterised as voters who believed they had been “left behind” – was the single most significant driver of Trump’s surprising victory, and suggest instead that changes in life expectancy rates was a key factor.

The report, published in the Journal of General Internal Medicine, found that in the 2016 presidential election counties recording an increased Republican had a 15% higher age-adjusted death rate per 100,000 people than counties with a net gain in Democratic voters.

Mortality rates in the US among lower-income, rural, non-Hispanic, white Americans have been rising, the report says, even as they are declining in blacks and Hispanics. Overall life expectancy in the US declined from 78.9 years in 2012 to 78.6 years in 2016.

Declines among younger, lower-income, non-Hispanic whites, especially those without a bachelor’s degree, more than offset gains among African-Americans. Increases in deaths of despair – those linked to suicide, or drug and alcohol abuse – approximately doubled between 2000 and 2015, contributing to this decline in life expectancy.

Although death rates are not the only marker of health and well-being, the Goldman and colleagues note, they might be a marker of relative despair.

“If so, it is not surprising that deaths related to alcohol, drugs, and suicides rose by 2.5 times as much in counties with a Republican percentage gain, compared with counties with a Democratic percentage gain since 2000,” they write.

“Although life expectancy is increasing in many parts of the country, especially in urban areas, we're not seeing nearly the same gains in rural and middle America,” says Goldman.

“We shouldn't underestimate the degree to which some portions of the country have been left behind in terms of their health. And it's not surprising that health disparities correspond with voting behaviour.”

The researchers examined voter data from the 2008 presidential election between Democrat Barack Obama and Republican John McCain, and the 2016 Clinton-Trump race.

They found that both 2016 candidates received fewer votes than the 2008 contenders in 398 counties. However, Trump polled better than McCain in 2607 counties, while Clinton surpassed Obama's totals in only 108 counties.

“It's commonly argued that President Trump won by receiving more votes from people who have been left behind economically – especially older, less-educated, and less-urban, white voters,” Goldman says.

“Based on our data, we can also say that changes in life expectancy were an independent factor in voting choices.”

He says the study shows how diminished health prospects are important markers of “dissatisfaction, discouragement, hopelessness, and fear – sentiments that may have resonated with voters who sided with President Trump”.

Goldman adds that correlation does not imply causality, but “our findings also suggest that plausible improvements in life expectancy in Michigan, Pennsylvania, and Wisconsin might have shifted their electoral votes to [Hillary] Clinton”.

“Regardless of your political persuasion,” he adds, “our paper suggests that if health disparities were important enough to influence presidential voting, they may have an even broader impact on our country's future than we had imagined.

“It also highlights how much work remains to reduce health disparities.”

The researchers found that counties which experienced zero or slow gains in income were significantly more likely to vote for Trump in 2016 than for McCain in 2008.

The researchers say Trump’s emphasis on non-Hispanic white voters was reflected by his better performance in counties that had smaller increases in ethnic and racial diversity.